Long-term Cardiac Effects of Modern Treatment for Hodgkin’s Lymphoma

Abstract

Abstract Background: Hodgkin’s lymphoma (HL) is a hematological malignancy that affects both children and young adults. Traditional treatment is associated with a life-time prevalence of cardiac disease exceeding 50%. In the late 1990s protocols were modified to reduce cancer therapy-related adverse cardiac effects. This study aimed to assess the long-term impact of advances in treatment protocols on the cardiac health of HL survivors (HLS). Methods: HLS (n=246) treated between 1997 and 2007 with anthracycline-based chemotherapy in three centers in Norway were included. Of these, 132 (53%) had also received mediastinal radiotherapy. HLS were compared to controls (n=58) recruited from the general population and matched for sex, age, smoking status, and heredity for coronary artery disease. All subjects underwent echocardiography, clinical assessment, and blood sampling. Results: The HLS were 46±9 years old and had been treated 17±3 years before inclusion in the study. There was no significant difference between HLS and controls in ejection fraction (EF) (58%±5 vs. 59%±4, p=0.08) or prevalence of heart failure. HLS treated with both anthracyclines and mediastinal radiotherapy (AC+MRT) had slightly worse left ventricular global longitudinal strain than controls (‑19.3±2.5% vs. -20.8±2.0%, p<0.001), but those treated with only anthracyclines did not. HLS treated with AC+MRT had a higher prevalence of valve disease than those treated only with anthracyclines (12% vs. 4%, p<0.05). Conclusions: HLS treated with anthracyclines after the late 1990s have similar cardiac outcomes as age-matched controls, apart from higher rates of valvular disease in those who also underwent mediastinal radiotherapy.